Search

Background and Purpose: Whether imaging parameters would independently predict stroke recurrence in low-risk minor ischemic stroke (MIS) or transient ischemic attack (TIA) according to traditional score system (such as ABCD 2 score, which was termed on the basis of the initials of the five factors: age, blood pressure, clinical features, duration, diabetes) remains unclear. We sought to evaluate the association between imaging parameters and 1-year stroke recurrence in patients with TIA or MIS in different risk stratum stratified by ABCD 2 score. Methods: We included patients with TIA and MIS (National Institutes of Health Stroke Scale score ≤3) with complete baseline vessel and brain imaging data from the Third China National Stroke Registry III. Patients were categorized into different risk groups based on ABCD 2 score (low risk, 0–3; moderate risk, 4–5; and high risk, 6–7). The primary outcome was stroke recurrence within 1 year. Multivariable Cox proportional-hazards regression models were used to assess whether imaging parameters (large artery stenosis, infarction number) were independently associated with stroke recurrence. Results: Of the 7140 patients included, 584 patients experienced stroke recurrence within 1 year. According to the ABCD 2 score, large artery stenosis was associated with higher stroke recurrence in both low-risk (adjusted hazard ratio, 1.746 [95% CI, 1.200–2.540]) and moderate-risk group (adjusted hazard ratio, 1.326 [95% CI, 1.042–1.687]) but not in the high-risk group ( P >0.05). Patients with multiple acute infarctions or single acute infarction had a higher risk of recurrent stroke than those with no infarction in both low- and moderate-risk groups, but not in the high-risk group. Conclusions: Large artery stenosis and infarction number were independent predictors of 1-year stroke recurrence in low-moderate risk but not in high-risk patients with TIA or MIS stratified by ABCD 2 score. This finding emphasizes the importance of early brain and vascular imaging evaluation for risk stratification in patients with TIA or MIS.

Background Studies have revealed that lncRNA HOXA11-AS contributes to regulating inflammation, while the role of HOXA11-AS in Parkinson's disease (PD) remains unclear. Methods Both in vivo and in vitro PD models were induced. Gain- or loss-assays of HOXA11-AS and miR-124-3p were conducted. The neurological functions, dopaminergic neurons damage, microglia activation of PD mice were measured. Afterwards, the expressions of inflammatory factors were examined with RT-PCR. Western blot was employed to detect the level of FSTL1, NF-κB and NLRP3 inflammasome. Meanwhile, bioinformatics analysis and dual-luciferase reporter assay were utilized to confirm the targeting relationships among miR-124-3p, HOXA11-AS and FSTL1. Results HOXA11-AS promoted MPTP-mediated SH-SY5Y neuronal injury and LPS-induced microglia activation, while miR-124-3p had the opposite effects. Additionally, miR-124-3p was the target of HOXA11-AS and FSTL1. HOXA11-AS overexpression enhanced the expression of inflammatory factors and FSTL1, NF-κB and NLRP3 inflammasome, while inhibiting NF-κB weakened HOXA11-AS-mediated neuronal damage and microglia activation. Moreover, HOXA11-AS1 downregulation ameliorated MPTP-induced neurological damages and neuroinflammation in mice. Conclusion Inhibition of HOXA11-AS protects mice against PD through repressing neuroinflammation and neuronal apoptosis through miR-124-3p-FSTL1-NF-κB axis.

Background The association between impaired fasting glucose and cardiovascular disease (CVD) in participants without atherosclerotic CVD (ASCVD) risk factors based on current definitions is unclear. The study aimed to examine the association of fasting glucose levels with CVD and its subtypes in persons without ASCVD risk factors. Methods This study included 38 297 participants [men 62.1%; mean age 47.9 (12.9) years] who were free of a history of CVD and absent of ASCVD risk factors and had a fasting plasma glucose (FPG) level between 70 to 125 mg/dL at baseline from Kailuan Study during 2006 and 2007. Participants were followed until new-onset CVD event, death, or December 31, 2017. Cox proportional hazards models were performed to evaluate the associations. Results During a median follow-up of 11.0 years (interquartile range 10.7-11.2 years), we observed 1217 incident CVD events. Compared with participants with FPG 70 to 99 mg/dL, the multivariable adjusted hazard ratios for CVD among participants with FPG 100 to 109 mg/dL and 110 to 125 mg/dL were 1.18 (95% CI 1.02-1.38) and 1.27 (95% CI 1.03-1.55), respectively. Multivariable-adjusted spline regression model showed a J-shaped association between FPG and the risk of CVD. Conclusions We found that among individuals without diabetes or other traditional ASCVD risk factors, there is an increased risk of incident CVD with increasing abnormal FPG levels. These results highlight the importance of primordial prevention for FPG level increases along with other traditional ASCVD risk factors.

Objective To identify a new genetic cause in patients segregating distal hereditary motor neuropathy (dHMN) with an autosomal recessive pattern. Methods Whole‐exome sequencing was conducted in two siblings and was combined with segregation analysis. Additionally, 83 unrelated dHMN patients with unknown genetic cause were screened. RNA analysis was performed using blood lymphocytes and HEK293 cells transfected with mutant plasmids. Immunohistochemistry and Western blot analysis was applied to the nerve tissue. The enzymatic activities of mutant proteins were measured in the cultured cells to verify the pathogenicity of variants. Results The clinical features of the patients showed late‐onset phenotype of distal motor neuropathy without sensory involvement. We identified that compound heterozygous variants of c.1342C>T and c.2071_2072delGCinsTT in the membrane metalloendopeptidase (MME) gene co‐segregated with the phenotype in a dHMN family. In an additional group of 83 patients with dHMN, compound heterozygous variants of c.1416+2T>C and c.2027C>T in MME were identified in one patient. The splice site variant c.1416+2T>C results in skipping of exon 13. The stop variant c.1342C>T induces mRNA degradation via nonsense‐mediated mRNA decay. Transcript levels of MME in the lymphocytes showed no significant differences between the patients and controls. We also identified that MME variants were associated with mild decrease in protein expression in the sural nerve and significant impairments of enzymatic activity. Interpretation Variants in the MME gene were associated with not only a Charcot‐Marie‐Tooth neuropathy phenotype but also with an autosomal‐recessive dHMN phenotype. Loss of function may play a role in the pathogenesis of dHMN.

Quantifying the variation of forest transpiration (T) is important not only for understanding the water and energy budget of forest ecosystems but also for the prediction, evaluation, and management of hydrological effects as well as many other ecosystem services of forests under the changes of climate, vegetation, and anthropological impacts. The accurate prediction of T, a key component of water used by forests, requires mechanism-based models describing the T response to environmental and canopy conditions. The daily T of a larch (Larix principis-rupprechtti) plantation was measured through monitoring the sap flow in the growing season (from May to September) of a dry year (2010), a normal year (2012), and a wet year (2014) at a shady slope in the semi-arid area of Liupan Mountains in northwest China. Meanwhile, the meteorological conditions, soil moisture, and forest canopy leaf area index (LAI) were monitored. To get a simple and easily applicable T model, the numerous influencing parameters were grouped into three factors: the atmospheric evapotranspiration demand indicated by the potential evapotranspiration (PET), the soil water supply ability indicated by the relative extractable soil water content (REW), and the vegetation transpiration capacity indicated by the forest canopy LAI. The T model was established as a continuous multiplication of the T response equations to individual factors, which were determined using the upper boundary lines of measured data. The effect of each factor on the T in a dry year (2010) or normal year (2012) was assessed by comparing the measured T in the baseline of the wet year (2014) and the model predicted T, which was calculated through inputting the actual data of the factor (i.e., PET) to be assessed in the dry or normal year and the measured data of other two factors (i.e., REW, LAI) in the baseline of the wet year. The results showed that the mean daily T was 0.92, 1.05, and 1.02 mm, and the maximum daily T was 1.78, 1.92, and 1.89 mm in 2010, 2012, and 2014, respectively. The T response follows a parabolic equation to PET, but a saturated exponential equation to REW and LAI. The T model parameters were calibrated using measured data in 2010 and 2012 (R2 = 0.89, Nash coefficient = 0.88) and validated using measured data in 2014 satisfactorily (R2 = 0.89, Nash coefficient = 0.79). It showed a T limitation in the dry year 2010 for all factors (18.5 mm by PET, 11.5 mm by REW, and 17.8 mm by LAI), while a promotion for PET (1.4 mm) and a limitation for REW (4.2 mm) and LAI (14.3 mm) in the normal year 2012. The daily T model established in this study can be helpful to assess the individual factor impact on T and improve the daily T prediction under changing environmental and canopy conditions.

Background: We aimed to explore the relationship between ZSCAN25 and CYP2E1 polymorphisms and Ischemic stroke (IS) susceptibility among a Chinese Han population.Methods: We enrolled 477 patients with IS and 480 age- and sex- matched health controls. Genotyping of the ZSCAN25 rs10242455, CYP2E1 rs2070672 and rs2515641 were performed by Agena MassARRAY platform. Odds ratio (OR) and 95% confidence interval (CI) were calculated by logistic regression analysis.Results: Rs10242455 (OR = 0.56, 95% CI: 0.34–0.93, p = 0.024) was associated with a reduced IS susceptibility, while rs2070672 (OR = 1.40, 95% CI: 1.12–1.75, p = 0.003) and rs2515641 (OR = 1.29, 95% CI: 1.01–1.64, p = 0.041) with an increased IS occurrence. Rs2070672 was observed to correlate with IS risk (OR = 4.06, p = 0.038) at age > 64 years, and rs10242455 (OR = 0.45, p = 0.021) and rs2070672 (OR = 3.28, p = 0.024) affected IS risk in males. In addition, rs10242455 (OR = 1.72, p = 0.014) was significantly associated with hypertension in IS patients.Conclusion: Our study firstly found that rs10242455 in ZSCAN25, rs2070672 and rs2515641 in CYP2E1 were associated with the occurrence of IS in a Chinese Han population.

OBJECTIVE: To evaluate the clinical application value of high frequency color Doppler ultrasound(HFCUS) combined with microvascular stapler in the repair of oral and maxillofacial defects with the anterolateral thigh perforator flap. METHOD: Forty maxillofacial malignant tumor patients were divided into HFCUS+stapler group(23 cases) and control group(17 cases). All of cases used anterolateral thigh flap without fascia lata to repair the soft tissue defect in the operative area. One artery and two veins were anastomosed during the operation. The flaps were harvested from 6.0 cm×7.0 cm to 10.0 cm×12.0 cm, and the donor sites were closed and sutured at the same time. In group HFCUS+stapler, HFCUS was used to locate the perforating vessels and mark the location on the body surface the operation, and the vein was anastomosed intraoperatively with a stapler. In the control group, only iliac patella line was fixed before operation, and the vein was manually sutured during operation. The clinical data of 2 groups was evaluated by comparing the time consumption of flap harvest, the vascular anastomosis, the incidence of postoperative venous crisis, and the long-term survival rate of flap. RESULT: In the HFCUS+stapler group, a total of 27 perforators were found before the operation, 24 perforators within 1.0 cm from the preoperative marker were actually detected during the operation, and the remaining 3 perforators were about 1.7 cm, 2.0 cm and 2.5 cm from the marker respectively, with an accuracy rate of 88.9%. HFCUS+stapler group used (63.17±7.80) min to harvest the flap, while the control group used (85.47±7.41) min HFCUS+stapler group took significantly less time than the control group(P < 0.001). The arterial anastomat time in the HFCUS+stapler group was (9.48±1.20) min and it was (9.18±1.13) min in the control group. The difference between the two groups was not statistically significant(P=0.426). The total anastomosis time of the two veins was (14.87±2.62) min in the HFCUS+stapler group and (33.06±3.86) min in the control group. The HFCUS+stapler group had significantly less anastomosing time than the control group(P < 0.001). In HFCUS+stapler group, no arteriovenous crisis occurred after operation, and all flaps survived well 15 days after operation. In the control group, 2 cases had venous crisis after operation(P=0.091). CONCLUSION: HFCUS combined with iliac patellar line can improve the accuracy of anatomical perforated vessels, reduce the time of flap harvesting, and reduce the possibility of accidental injury of perforated vessels. The use of microvascular stapler for vein anastomosis can reduce the operation time and improve the survival rate of flap. The combination of the two can significantly reduce the operation time of microsurgical repairing maxillofacial soft tissue defect, improve the operation quality, and has higher clinical application value.

Background: Evidence demonstrated diffusion-weighted imaging (DWI) lesions of different age predicted future stroke in transient ischemic attack (TIA) patients. The aim of this study is to develop a novel score (mABCD3-I) by replacing dual TIA with DWI lesions of different age and externally validate it in a multicenter TIA cohort. Methods: We conducted a prospective cohort study. The predictive outcome was stroke/all-cause death. Cox proportional hazards model was used to evaluate the predictive value of risk factors. The area under the curves (AUC) and net reclassification improvement (NRI) were used to present the discriminative and risk stratification abilities. Results: 2283 patients were included: 1077 in the derivation cohort and 1206 in the validation cohort. We derived mABCD3-I score by replacing dual TIA with DWI lesions of different age based on results of the multivariate analysis (Table 1). In the derivation cohort (Table 2), the AUCs for the mABCD3-I score were 0.78 at 90-day (95% confidence interval [CI]: 0.75-0.80; compared with ABCD3-I score, p=0.002), 0.78 at 6-month (95%CI: 0.75-0.81; p=0.008) and 0.78 at 1-year (95%CI: 0.75-0.81; p=0.018). The mABCD3-I score improved the reclassification at 90-day (p=0.006) and 6-month (p=0.033). In the validation cohort, the mABCD3-I had equal discriminative abilities compared with ABCD3-I score at 90-day (p=0.056) and 6-month (p=0.054), and higher ability at 1-year (p=0.044). Conclusions: Replacing dual TIA with DWI lesions of different age in ABCD3-I score improved risk prediction for stroke/death risk after TIA.

Background. Increased blood pressure (BP) variability may worsen the prognosis of stroke. This study aimed at investigating the association between BP variability and early functional prognosis in patients with pontine infarction. Methods. According to types of pontine infarction, all the 137 patients were divided into two groups: 70 patients with paramedian pontine infarction (PPI) and 67 patients with deep pontine infarction (DPI). Common risk factors, 24-hour continuous blood pressure monitoring data, and the coefficient of variation were collected after admission in the hospital. Functional outcomes were evaluated with modified Rankin scale (mRS) at 3 months after discharge (favorable outcome: mRS scores ≤ 2; poor outcome: mRS scores > 2). Results. The level of Glu, HbA1c, LDL, and NIHSS scores in the PPI group was significantly higher than that in the DPI group, and the concentration of blood uric acid was lower in the PPI group. Diastolic pressure in the PPI group is significantly higher than that in the DPI group, and coefficient of variation (CV) of systolic pressure in PPI is higher when compared with DPI ((88.77 ± 1.71) mmHg vs. (80.74 ± 1.31) mmHg; (11.54 ± 0.35) vs. (10.24 ± 0.25)). In multivariate analyses, the CV of systolic pressure, diastolic pressure, NIHSS scores, and the paramedian pontine infarction was independently associated with 3-month clinical outcome (OR = 1.94, 95% CI = 1.252–2.994, P=0.003; OR = 1.08, 95% CI = 1.002–1.166, P=0.04; OR = 1.58, 95% CI = 1.164–2.159, P=0.003; OR = 9.87, 95% CI = 1.045–32.193, P=0.04). Conclusion. In conclusion, increased 24-hour (BP) variability, NIHSS scores, and paramedian pontine were associated with early poor prognosis in patients with acute pontine infarction.

The differences in molecular mechanisms between osteochondroma and bizarre parosteal osteochondromatous proliferation (BPOP) remain to be fully elucidated. In the present study, the differentially expressed genes between BPOP and osteochondroma were obtained from the Gene Expression Omnibus online database, and the associations among these genes were analyzed using the Database for Annotation, Visualization, and Integrated Discovery (DAVID) online bioinformatics software. The results revealed several differentially expressed genes between human BPOP and osteochondroma. These differentially expressed genes were also enriched in different subgroups based on the analysis using DAVID online software, including ‘transforming growth factor β receptor signaling pathway’, ‘BMP signaling pathway’, ‘Wnt receptor signaling pathway’, ‘response to chemical stimulus’, ‘regulation of inflammatory response’, ‘response to stress’, ‘glycosaminoglycan binding’, ‘polysaccharide binding’, ‘extracellular matrix structural constituent’ and ‘growth factors binding’. Taken together, these findings led to the conclusion that different gene regulatory mechanisms exist between BPOP and osteochondroma. Environmental stimulation and inflammation may contribute to BPOP or osteochondroma, and differences in extracellular matrix may contribute to differences in biological characteristics between BPOP and osteochondroma.

Background This study aims to analyze the clinical, imaging, electrophysiological, and dermatopathological features of a patient with adult‐onset neuronal intranuclear inclusion disease (NIID) and to explore the diagnostic methods of adult‐onset NIID. Case presentation We here report a 63‐year‐old male with recurrent acute encephalopathy syndrome and autonomic nervous system damage syndrome characterized by sexual dysfunction and urinary and fecal dysfunction. Cranial diffusion‐weighted magnetic resonance imaging (DWI) demonstrated symmetrically distributed strip‐shaped high‐intensity signal in bilateral fronto‐occipital‐parietal cortical‐medullary junction. Electrophysiological test revealed that the main site of injury was myelin sheath in both motor and sensory nerves. Skin biopsy revealed eosinophilic spherical inclusion bodies in the nucleus of sweat gland epithelial cells. Conclusion This case suggests that adult NIID is a chronic neurodegenerative disease with high clinical heterogeneity. Subcortical strip‐shaped high‐intensity signal on DWI has high diagnostic significance. Eosinophilic intranuclear inclusion bodies detected by skin biopsy contribute to diagnosis., Adult‐onset neuronal intranuclear inclusion disease (NIID) has a low incidence, diverse clinical manifestations, and difficulty in early diagnosis. NIID has typical clinical manifestations and suggestive MRI features. The use of skin biopsy with minimal trauma can promptly diagnose NIID and improve the awareness of the clinicians.

OBJECTIVE: This study aimed to explore further the mechanisms of tongue squamous cell carcinoma (TSCC) cell recurrence, metastasis, and diffusion, as well as to establish the experimental basis for the molecular biology research on TSSC. We intend to complete our objective through differential proteomics and preliminary analysis protein expression of exosomes derived from TSCC and normal mucosa cells. METHODS: We acquired cultured supernatant fluid in vitro in the laboratory by culturing TSCC (tongue cancer Tca8113 cell line) and human normal mucosa cells (HOK cell line). The exosomes were separated and purified through differential centrifugation. Furthermore, the different protein expressions were identified through dielectrophoresis and mass spectrometry. The functions of the different protein expressions were identified through an online database search. RESULTS: TSCC and human normal mucosa cells secrete a large amount of capsule bubble structure substances in vitro, as confirmed by electron microscopy and surface markers heat shock protein-70 and major histocompatibility complex class Ⅰ. A total of 16 oral cancer cell-derived exosomes that expressed quantity more than two times, twelve that increased their expression levels, and four that cut their expressions were identified through the differential proteomics research on the two groups. CONCLUSION: Differential proteins that were verified through the online database serve an important function in exosome formation and in the progress of cancer.